1228

be. As in the case described by Dr. Klajman and Dr.Efrati, in our cases the gall-bladder did not fill with

opaque dye and the patients were in excellent health.EUGENE STRANSKY.Department of Pædiatrics, College

of Medicine, University of thePhilippines, Manila.

1. Poulton, E. M., Hinden, E. Arch. Dis. Childh. 1953, 28, 392.2. Hansen, R. E. A. S. Brit. med. J. 1954, i, 1038.

ENURESIS

MICHAEL J. COSGRAVE.Rainhill Hospital,near Liverpool.

SIR,-Following the recent correspondence, I wish tocite the following case, treated at the Liverpool RoyalInfirmary, which seems to fall into the category of

" acquired relative nocturnal polyuria." 1A youth of 20, an only child, was said to have first had

nocturnal enuresis at the age of 10. He was referred to the

psychiatric outpatient clinic after being fully investigatedphysically and " having had every treatment except hyp-nosis." He was accordingly treated by hypnosis and suggestionfor some months but his condition showed only slight improve-ment. During the past few months he has been treated withposterior-lobe pituitary snuff (’ Disipidin ’), as advocated byHansen,2 and improvement has been marked.The initial dose was gr. 1 (60 mg.) at night and this gave

an immediate good result. Five weeks later, without thepatient’s knowledge, an inert snuff was substituted, and thiswas followed by a complete relapse. Disipidin was restartedat gr. P/2 (90 mg.) at night and later increased to gr. 2

(120 mg.). The accompanying table illustrates the results.

DRY AND WET NIGHTS PER TWO-WEEK PERIOD DURING

TREATMENT WITH DISIPIDIN

A = inert powder for last seven days of this fortnight. Six ofthese nights were wet.

Dr. Poulton (March 19) points out that it is possibleby bladder training alone to achieve control, even in thecase of a patient excreting equal volumes by day andnight, but goes on to say " in general, ancillary aid mustbe brought to bear."The case I have described suggests that posterior-

pituitary snuff, by increasing absorption by the

epithelium of the renal tubules, might have a useful placein the treatment of cases classifiable as absolute polyuriaand relative nocturnal polyuria.

STERILISATION OF SYRINGES

J. G. ALEXANDERW. N. ROLLASON.

SIR,—In your annotation of Jan. 22 you state that" autoclaving is unsatisfactory because the syringes havefirst to be taken apart." This was challenged by one ofus (W. N. R.) in your issue of Feb. 19, and in their replyof March 5 Dr. Darmady and Dr. Hughes state : " IfDr. Rollason likes to carry out the simple experiment ofplacing dried spores in the bottom of the barrel with theplunger in position he will soon be convinced that auto-claving under these conditions is not desirable as a

method." Such an experiment has now been carriedout by one of us (J. G. A.) using the autoclaves in manyof the hospitals in this area.The spores used were the same as those used by Dr.

Darmady and Dr. Hughes-namely, those contained in"

green label " earth as kindly supplied by Dr B. W. Lacey,of the Westminster Hospital, London. These spores are moreresistant than those of Bacillus subtilis as obtained from theNational Collection of Type Cultures and are stated by Dr.Lacey to be killed only after exposure to 115°C for fifteenminutes.

All-glass syringes (10 ml.) were used, some of them beingoiled. The needles were not attached. On two occasions the

syringes were inside metal containers, care being taken that

there was an opening in the container to allow the entrance ofsteam. In the other ten instances they were in glass tubesand care was taken to ensure that the plug was permeablewhile in the autoclave. The results obtained show very clearlythat an efficient autoclave is all-important and that it willkill these spores in the assembled syringe at a temperature of120°C at a pressure of 20 lb. for twenty minutes.One theatre autoclave was successful at 15 lb. for fifteen

minutes. The others have not been tested at this pressure.Two rather old laboratory autoclaves were successful at

20 lb. for twenty minutes, but not at 15 lb. for fifteen minutes.One old theatre autoclave was unsuccessful on two occasionsat 20 lb. for twenty minutes. It has since been replaced by anew one. It is important to note that this old autoclavesuccessfully killed spores of B. subtilis (as obtained from theNational Collection of Type Cultures) when used on a stripof’ filter paper.The experiments show that autoclaving at a tempera-

ture of 1200U at a pressure of 20 lb. for twenty minutes,as stated in the M.R.C. leaflet on the Sterilization, Use,and Care of Syringes (1945) and quoted in the letter byone of us (W. N. R.) (Feb. 19), is a satisfactory methodof sterilisation of assembled syringes.

J. G. ALEXANDER.Hull. AIT. N. ROLLASON.

ObituaryCHARLES WILLIAM BUCKLEY

M.D. Lond., F.R.C.P.

Dr. Buckley, whose death we announced last week,was a leading authority on rheumatism, his greatexperience being gained as a spa physician at Buxton inDerbyshire.Born at Derby in 1884 and educated privately, he

came to London with an entrance scholarship atSt. Mary’s Hospital and qualified in 1898. In the earlyyears of the century he settled in practice in Buxton,but it was not until 1912 that, after many unsuccessfulattempts, he obtained appointment to the staff of’the Devonshire Hospital forRheumatic Diseases, forwhich he was to do so muchand to which he broughtso much renown. He becameM.R.c.p. in 1923, when generalpractitioners were madeeligible for membership ofthe Royal College of Physi-cians, and after discontinuinggeneral practice, he was

elected to the fellowship in1933.A fine clinician, Buckley

communicated his knowledgeon many aspects of rheuma-tism. His writings, alwaysimmaculately presented,appeared at intervals over

the years in many medicaljournals and textbooks. Hislast article appeared in 1948, his last chapter in 1955;and both were completely up to date. The subjectwhich interested him most, and to which he contributedmuch, was ankylosing spondylitis. The first of his paperson this disease, which at that time was seldom recognised.appeared in 1932 ; it was based on the study of 150 cases.Rather surprisingly, he produced only one book-ahandbook for the general practitioner entitled Artfiritis,Fibrositis, and Gout. His greatest contribution to thespecialty was his editing, first of the Royal College ofPhysicians reports on rheumatic diseases, and later ofthe Annals of the Rheumatic Disectses-a journal foundedby the Empire Rheumatism Council and subsequentlyadopted by many Rheumatic Associations both inEurope and in America.He was a member of many medical societies, both

national and international. He served on the scientific.-educational, and editorial committees of the EmpireRheumatism Council, and he held office as president of